The feasibility of an allergy management support system (AMSS) for IgE-mediated allergy in primary care.

BACKGROUND: The allergy management support system (AMSS) was developed to assist general practitioners (GPs) to handle the increasing burden of allergic diseases and facilitates the diagnosis and management of allergy. The aim of this cluster-randomized controlled pilot study was to test the feasibility of this AMSS for primary care. METHODS: GPs received diagnostic and management recommendations generated by the AMSS in addition to sIgE-test results (intervention) or GPs received sIgE-test results only (control). The AMSS recommendations are based on the previously developed patient-completed AMSS questionnaire and sIgE-test results. The AMSS was considered feasible when > 70% of the AMSS recommendations were sent to the GP within ten working days of sIgE-testing. GPs completed a questionnaire on their diagnosis and management before (T1) and after (T2) receiving sIgE test results. Agreement and disagreement concerning diagnosis, medication and referrals between GPs and AMSS was investigated at T1 and T2. A total agreement score between GPs and AMSS was calculated. GPs in the intervention group completed a questionnaire to evaluate the utility of the AMSS. Semi-structured interviews were used to explore the motivation of GPs who did not include patients in this pilot study. RESULTS: Twenty-seven GPs included 101 patients. Forty-two patients (72%) completed the AMSS questionnaire in the intervention group. The majority of the AMSS recommendations (93%) were returned to the GP within 10 working days after sIgE-test results were known [mean (SD) 4.7 (4.0) working days]. GPs in the intervention group reported largely following the AMSS recommendations in 71% of cases. The total agreement scores concerning diagnosis were significantly higher (p < 0.001) in the intervention group than the control group [mean (SD); 0.9 (1.8) vs - 0.8 (1.0)]. The agreement concerning medication or referral between GPs and AMSS did not differ between the intervention and the control group. GPs in the intervention group were reasonably positive about the AMSS. Not enrolling patients was not caused by anticipated ineffectiveness of the AMSS. CONCLUSION: The AMSS can be considered to be feasible for primary care. GPs tend to follow the AMSS recommendations. The AMSS may contribute to the empowerment of GPs to better manage allergy patients in primary care.Trial registration ISRCTN ISRCTN36780877. Registered 23 November 2017 (retrospectively registered).

Development of an allergy management support system in primary care.

BACKGROUND: Management of allergic patients in the population is becoming more difficult because of increases in both complexity and prevalence. Although general practitioners (GPs) are expected to play an important role in the care of allergic patients, they often feel ill-equipped for this task. Therefore, the aim of this study was to develop an allergy management support system (AMSS) for primary care. METHODS: Through literature review, interviewing and testing in secondary and primary care patients, an allergy history questionnaire was constructed by allergists, dermatologists, GPs and researchers based on primary care and specialists' allergy guidelines and their clinical knowledge. Patterns of AMSS questionnaire responses and specific immunoglobulin E (sIgE)-test outcomes were used to identify diagnostic categories and develop corresponding management recommendations. Validity of the AMSS was investigated by comparing specialist (gold standard) and AMSS diagnostic categories. RESULTS: The two-page patient-completed AMSS questionnaire consists of 12 (mainly) multiple choice questions on symptoms, triggers, severity and medication. Based on the AMSS questionnaires and sIgE-test outcome of 118 patients, approximately 150 diagnostic categories of allergic rhinitis, asthma, atopic dermatitis, anaphylaxis, food allergy, hymenoptera allergy and other allergies were identified, and the corresponding management recommendations were formulated. The agreement between the allergy specialists' assessments and the AMSS was 69.2% (CI 67.2-71.2). CONCLUSION: Using a systematic approach, it was possible to develop an AMSS that allows for the formulation of diagnostic and management recommendations for GPs managing allergic patients. The AMSS thus holds promise for the improvement of the quality of primary care for this increasing group of patients.

Targeting cancer patients' quality of life through social comparison: a randomised trial.

OBJECTIVE: Former cancer patients' quality of life can be improved by offering social comparison information. Whether patients, however, benefit from the information may depend on how negative they perceive their present and their future. DESIGN: We conducted a randomised experimental field study with a pre- and post-measurement. Dutch former cancer patients - recruited through different media - were assigned to a social comparison intervention condition or a no-intervention control condition (experimental condition n = 62; control condition n = 88; Mage = 52 years). In the intervention condition, patients received a 20 min computer-tailored interview in audio format. Patients' present perceived life threat and future health expectations were measured at pretest. MAIN OUTCOME MEASURES: Quality of life and life satisfaction after 2 months were the outcome variables. RESULTS: The intervention increased life satisfaction only in patients who experienced a high present life threat ([Formula: see text] = .08) and in patients who had negative future health expectations, the intervention increased quality of life ([Formula: see text] = .05). CONCLUSIONS: Not all patients did benefit from the intervention; for some patients, the social comparison intervention was even detrimental. Moderator analyses seem necessary to evaluate psycho-social interventions for cancer patients.

Effects of the source of social comparison information on former cancer patients' quality of life.

OBJECTIVE: Life, following curative treatment, can be a struggle for former cancer patients. In this phase of their illness, social comparison information may help to improve a patient's quality of life (QOL). The objective of this study was to determine whether the effects of this information depend on the following two variables: (1) the individual's physical health and (2) the individual's sensitivity to social comparison. DESIGN: In the current study, the effects on a patient's QOL were tested that occur when they are listening to a psychological oncological expert talking about cancer patients' experiences. Three different recorded interviews with experts were compared (on negative emotions, effective coping, or both), and individual differences were tested as moderators. In addition, the expert source conditions were compared with a condition in which the source was not an expert but a former patient. METHODS: In a randomized field experiment, 154 Dutch former cancer patients (M(age) = 55 years; 68% women) were assigned to one of the four conditions (three expert source and one former patient source condition). QOL was assessed after 2 months. RESULTS: The effects of the expert source conditions on QOL depended on the participants' physical health (good vs. poor) and on the participants' sensitivity to social comparison (whether the recipient reacts with contrast or identification), as indicated by significant three-way interactions (p < .001). Depending on these two variables, one of the three expert source conditions was at least as effective as the former patient source condition. CONCLUSIONS: The results show that desired and undesired effects are found when individual differences relevant to the processing of intervention information are examined.

Impact of social comparison on cancer survivors' quality of life: an experimental field study.

OBJECTIVE: For cancer survivors, the recovery phase after hospital treatment can be bothersome. Social comparison information from fellow cancer survivors can improve the quality of life in this situation. METHOD: In a randomized field experiment, 139 Dutch cancer survivors (M(age) = 52 years; 70.5% women) were assigned to a control condition or 1 of 3 experimental conditions in which they listened to an interview with fellow cancer survivors. The interview's content is about patients' negative emotions and/or the effective coping strategies patients used. A validation study among 101 students showed that the conditions were perceived as intended. In the main study, quality of life was assessed after 2 months (using the LASA, Cantrils' Ladder, and 2 items of the EORTC-C30). RESULTS: The effects of the interviews depended on the participants' self-reported health status and sensitivity to social comparison information (p < .001). Highly sensitive patients with a good health status benefited from the information; in those not sensitive, quality of life diminished. In patients with a poor health status, the effects were reverse. CONCLUSIONS: This study showed that a brief intervention comprised of testimonials of fellow cancer survivors had an impact on the quality of life of cancer survivors after 2 months. However, subgroups of patients were detected whose quality of life decreased because of the intervention. These results stress the need to be careful in providing social comparison information and to consider side effects of psychosocial interventions.